Progressive Pharmacies will post your open Accounts receivable Claim level data from you either from your pharmacy software vendor or from your pharmacy switch vendor. Once posted your claims data will be reviewed for validity and completeness. Payment Data Detail will be received and processed and will be matched at the claim level detail including RX number, fill date and other data elements to insure a unique one to one match occurs. This claim level reconciliation is how we can identify underpayments, overpayments, non-compliance to contract terms/rates and provide necessary feedback to the PBM’s to remedy any non-compliance issues. Additionally we utilize payment forecasting tools to know when payments are anticipated and whether or not they are compliant with the PBM’s own contract terms.

• On a weekly basis, Progressive Pharmacies will import and post claims as an open item accounts receivable, for all of your claim data from your PBMs Insurance Plans and third party plans, and we will Verify and Validate the Data for accuracy and completeness.
• Post Payments received under the Cash Management Systems, all Payments received from the PBM’s, Insurance Plans and other third party payers.
• Conduct a one to one open item claim receivable matching process with the corresponding unique payment detail records.
• Research, and follow up on all outstanding claims
• Archive of all reconciliation data.
• Research and follow up on all rejected and denied payments.
• Research and follow up on all unmatched and underpaid claims. Suspense & Exceptions
• Provide a monthly, summary aging of all unpaid claims by payer.